6 ms·

"The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor.

"The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are." I'm the spouse/partner of a recently-trained doctor, and I'm a programmer and startup founder with 2 decades of experience. With all respect, you have no friggen clue what you're talking about.

mistermann 7y ago
Would it be possible for you to be more specific about the ways in which the commenter is wrong?
- SiempreViernes 7y ago
  Have tech solved the issues of a client changing their minds about what they want? Well, all the interesting bits of medicine are built on social interactions. You ask the patient where it hurts and they lie about where.
  - mistermann 7y ago
    I don't think this is relevant to my question, or am I missing something?
  - maximente 7y ago
    are those the same social interactions that explain why surgeons resisted using things like checklist because it was "beneath them", "they never make mistakes", etc.? because if so i agree, there's some real low hanging fruit there.
mLuby 7y ago
Would you kindly elaborate on that? I have enormous respect for the difficulty of the training that doctors like your spouse have gone through, and yet I share the quoted sentiment. We assume that difficulty is essential to the work, and I think that's an assumption worth questioning, as the dental profession has been recently.
rhinoceraptor 7y ago
Yes, doctors are very smart and well trained. But medicine as a whole has a lot of completely insane practices. For example, have you ever tried to sleep in a hospital? They generally run very cool, daylight temperature lights 24/7, with tons of noisy machines, and the nurses wake patients every hour. And it's not just the patients who are getting their circadian rhythms destroyed, the residents themselves are doing 30+ hour shifts. It dates back to the first medical residency, started by William Stewart Halsted who was a cocaine fiend and expected everyone else to keep the same hours. We know that sleep deprivation impairs your driving ability just as much as being drunk. So why do we accept doctors and nurses being sleep deprived?
- watwut 7y ago
  My understanding is that they believe they are exception to the rule and that such schedule is more effective for them.
- rscho 7y ago
  Because money. You may become sick and have to deal with a sleep-deprived doc someday. But you have to pay said doc every month as sure as the sun rises. Plus, being sick only happens to others, right?
chronic7382 7y ago
> I'm the spouse/partner of a recently-trained doctor, and I'm a programmer and startup founder with 2 decades of experience. With all respect, you have no friggen clue what you're talking about. Then you should know very well that the entire MD education pipeline optimizes for rote memorization and regurgitation of facts (from undergrad pre-med all the way through post-residency fellowships). Any patient with even the slightest deviation from what the physician searched on WebMD is given generic advice similar to how fortune tellers recite generic phrases. If you have a non-standard question or health problem, go to 3 doctors (or even specialists) and you'll get 3 different answers. I work closely with clinicians at Tier 1 urban medical institutions daily, both at the in-patient and outpatient settings. Most doctors are dumb as a rock. Note: Physicians with a MD/PhD are much better at critical thinking and make more of an effort to solve your problem.
- scarface74 7y ago
  By definition, most patient issues don’t deviate from the normal. Optimizing for the most common case makes sense.
- mistermann 7y ago
  This lines up extremely well with my personal experiences over the years. It makes total sense if you think about it: medicine is an infinitely complex field, and at the end of the day even though doctors have (in the past) undertaken significant training, they are still human beings, subject to the same limitations and errors as the rest of us. New discoveries and nuanced understandings are made in medicine constantly, the idea that it is safe to assume that any individual doctor is going to know and understand all discoveries seems to me like extremely wishful thinking.
- programmertote 7y ago
  I can second this! I studied medicine for two years in a SE Asian country. My late dad was a doctor. Both of my host family parents are doctors in the US. My gf is a doctor. The main reason I left med school and decided to study math and comp sci. is because of the need of rote memorization necessary in medical training. This is especially worse in the US because the system here requires 4 yrs (undergrad) + 4 yrs (med school) + 3 yrs (residency) = 11 years of training to become a doctor. In contrast, it takes 5 yrs (med school) + 2-3 yrs (residency) of training to become a doctor in my home country. The journey to become a doctor in the US is unnecessarily lengthy and it makes doctors feel more entitled (because they have spent a lot of time and money as investment) to charge exorbitant fees despite what most of them are doing is simply prescribing antibiotics; analgesic; insulin; and garden-variety stuff (or read up "Up-to-date" [https://www.uptodate.com/home https://www.uptodate.com/home] to refresh on what they learned or what the current consensus treatment is). Most of them do the same thing day-in-day-out. Sure, there may be some specialists that are top notch, but they are like the minority and even their work is mostly about being able to keep steady hand and cool head during emergency situations.
amelius 7y ago
Yes, but doctors often refer to us as "the IT guys", and also have no idea what they're talking about.
dang 7y ago
> you have no friggen clue what you're talking about Please do better than this, regardless of how wrong or ignorant another comment is. Your post gives us no information other than about yourself. If you know more, please share some of what you know so the rest of us can learn. Please don't just name-call. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.
- tptacek 7y ago
  I winced at this comment too, because of that line, but have to point out that the "other side" of this argument could stand to be a lot more respectful as well. The "most doctors are dumb" sentiment on this thread fits the caricature lots of people have in their heads about how "HN people" think.
  - arkades 7y ago
    I don't really think it's a caricature. "Doctors are idiots following algorithms and don't actually have any knowledge or information and just scam everyone for money all the time until their eventual replacement by the first person who thinks of feeding electronic medical records to machine learning algos" would cover about 95% of HN comments in these sorts of threads. You might cover another 2% with variants of "there's no point in going to a doctor for your problem, any decent engineer can just spend a few dozen hours reading up on their problem and figure it out just as well." It's gotten to the point where I only chime in once in a while when the thread has gone deeply, deeply, off the deep end. But then, HN seems to have variants of that attitude towards pretty much every profession that doesn't have an engineering degree.
- pixelmonkey 7y ago
  Sorry. You're right, dang, I could have done better. I was not intending to name-call; to me, the entire comment was wrong and I posted a curt reaction. I'll provide more info here: "The level of legitimacy and respect that doctors and hospitals currently have is far too high..." Ask any young doctor in the US whether their field has a lot of "respect". Medical residents work 80-100 hours per week in windowless, flourescently lit rooms, of which 40-60 hours is often spent doing clerical work at sub-minimum-wage to service private insurance and EMR overlords. Patients regularly tell these same doctors they don't trust them, don't respect them, think they're wrong, want to see the "real" doctor, can prove how wrong they are with WebMD, etc. My spouse is now doing her 13th and 14th year of post-secondary training toward the goal of being a specialized surgeon. She has done hundreds of successful surgeries/procedures already and saved countless lives. Yet, she is burnt out, and often ends her workdays completely destroyed by the humiliation of being a cog in the hospital machine. She is not alone; physician depression and suicide is at all-time highs. "... and hinges on branding and the exclusivity of becoming a doctor." Like I said, she is on her 13th and 14th year of post secondary training. Aside from this being a massive time investment, it also cost her dollars she didn't have (no support from parents) on order of $300k in post-secondary education, just in tuition. If becoming a doctor is "exclusive" and confers a "brand", I'd say the exclusivity is "extreme passion for helping humans at great personal sacrifice and cost", and the conferred "brand" is that you are allowed to practice medicine, at all. "Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are." Medicine -- and the tireless and ethical work of thousands of well-trained and professional doctors -- saves countless, countless lives every single day. Modern medical treatments are not "worthless" and your comment is honestly insulting to how effective and life-saving many treatments are. I think this part of your comment is what got the rise out of me: spreading this kind of misinformation is the closest thing HN commenting gets to "malpractice". Society should respect and pay doctors much more for the sacrifice they put toward this profession. Patients should respect doctors a lot more for the benefit they provide society. Hospitals should give doctors a better work environment. Doctors are not perfect, nor is medicine. But to think the root cause of problems in the present medical system is an undeserving respect for doctors and modern medical treatments expresses a profound ignorance of reality. The original comment is so wrong that it truly stunned me into an uncharacteristically curt ad hominem response, for which I apologize.

mistermann 7y ago

Would it be possible for you to be more specific about the ways in which the commenter is wrong?

SiempreViernes 7y ago
Have tech solved the issues of a client changing their minds about what they want? Well, all the interesting bits of medicine are built on social interactions. You ask the patient where it hurts and they lie about where.
- mistermann 7y ago
  I don't think this is relevant to my question, or am I missing something?
- maximente 7y ago
  are those the same social interactions that explain why surgeons resisted using things like checklist because it was "beneath them", "they never make mistakes", etc.? because if so i agree, there's some real low hanging fruit there.

mLuby 7y ago

Would you kindly elaborate on that? I have enormous respect for the difficulty of the training that doctors like your spouse have gone through, and yet I share the quoted sentiment. We assume that difficulty is essential to the work, and I think that's an assumption worth questioning, as the dental profession has been recently.

rhinoceraptor 7y ago

Yes, doctors are very smart and well trained. But medicine as a whole has a lot of completely insane practices. For example, have you ever tried to sleep in a hospital? They generally run very cool, daylight temperature lights 24/7, with tons of noisy machines, and the nurses wake patients every hour. And it's not just the patients who are getting their circadian rhythms destroyed, the residents themselves are doing 30+ hour shifts. It dates back to the first medical residency, started by William Stewart Halsted who was a cocaine fiend and expected everyone else to keep the same hours. We know that sleep deprivation impairs your driving ability just as much as being drunk. So why do we accept doctors and nurses being sleep deprived?

watwut 7y ago
My understanding is that they believe they are exception to the rule and that such schedule is more effective for them.
rscho 7y ago
Because money. You may become sick and have to deal with a sleep-deprived doc someday. But you have to pay said doc every month as sure as the sun rises. Plus, being sick only happens to others, right?

chronic7382 7y ago

> I'm the spouse/partner of a recently-trained doctor, and I'm a programmer and startup founder with 2 decades of experience. With all respect, you have no friggen clue what you're talking about. Then you should know very well that the entire MD education pipeline optimizes for rote memorization and regurgitation of facts (from undergrad pre-med all the way through post-residency fellowships). Any patient with even the slightest deviation from what the physician searched on WebMD is given generic advice similar to how fortune tellers recite generic phrases. If you have a non-standard question or health problem, go to 3 doctors (or even specialists) and you'll get 3 different answers. I work closely with clinicians at Tier 1 urban medical institutions daily, both at the in-patient and outpatient settings. Most doctors are dumb as a rock. Note: Physicians with a MD/PhD are much better at critical thinking and make more of an effort to solve your problem.

scarface74 7y ago
By definition, most patient issues don’t deviate from the normal. Optimizing for the most common case makes sense.
mistermann 7y ago
This lines up extremely well with my personal experiences over the years. It makes total sense if you think about it: medicine is an infinitely complex field, and at the end of the day even though doctors have (in the past) undertaken significant training, they are still human beings, subject to the same limitations and errors as the rest of us. New discoveries and nuanced understandings are made in medicine constantly, the idea that it is safe to assume that any individual doctor is going to know and understand all discoveries seems to me like extremely wishful thinking.
programmertote 7y ago
I can second this! I studied medicine for two years in a SE Asian country. My late dad was a doctor. Both of my host family parents are doctors in the US. My gf is a doctor. The main reason I left med school and decided to study math and comp sci. is because of the need of rote memorization necessary in medical training. This is especially worse in the US because the system here requires 4 yrs (undergrad) + 4 yrs (med school) + 3 yrs (residency) = 11 years of training to become a doctor. In contrast, it takes 5 yrs (med school) + 2-3 yrs (residency) of training to become a doctor in my home country. The journey to become a doctor in the US is unnecessarily lengthy and it makes doctors feel more entitled (because they have spent a lot of time and money as investment) to charge exorbitant fees despite what most of them are doing is simply prescribing antibiotics; analgesic; insulin; and garden-variety stuff (or read up "Up-to-date" [https://www.uptodate.com/home https://www.uptodate.com/home] to refresh on what they learned or what the current consensus treatment is). Most of them do the same thing day-in-day-out. Sure, there may be some specialists that are top notch, but they are like the minority and even their work is mostly about being able to keep steady hand and cool head during emergency situations.

amelius 7y ago

Yes, but doctors often refer to us as "the IT guys", and also have no idea what they're talking about.

dang 7y ago

> you have no friggen clue what you're talking about Please do better than this, regardless of how wrong or ignorant another comment is. Your post gives us no information other than about yourself. If you know more, please share some of what you know so the rest of us can learn. Please don't just name-call. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.

tptacek 7y ago
I winced at this comment too, because of that line, but have to point out that the "other side" of this argument could stand to be a lot more respectful as well. The "most doctors are dumb" sentiment on this thread fits the caricature lots of people have in their heads about how "HN people" think.
- arkades 7y ago
  I don't really think it's a caricature. "Doctors are idiots following algorithms and don't actually have any knowledge or information and just scam everyone for money all the time until their eventual replacement by the first person who thinks of feeding electronic medical records to machine learning algos" would cover about 95% of HN comments in these sorts of threads. You might cover another 2% with variants of "there's no point in going to a doctor for your problem, any decent engineer can just spend a few dozen hours reading up on their problem and figure it out just as well." It's gotten to the point where I only chime in once in a while when the thread has gone deeply, deeply, off the deep end. But then, HN seems to have variants of that attitude towards pretty much every profession that doesn't have an engineering degree.
pixelmonkey 7y ago
Sorry. You're right, dang, I could have done better. I was not intending to name-call; to me, the entire comment was wrong and I posted a curt reaction. I'll provide more info here: "The level of legitimacy and respect that doctors and hospitals currently have is far too high..." Ask any young doctor in the US whether their field has a lot of "respect". Medical residents work 80-100 hours per week in windowless, flourescently lit rooms, of which 40-60 hours is often spent doing clerical work at sub-minimum-wage to service private insurance and EMR overlords. Patients regularly tell these same doctors they don't trust them, don't respect them, think they're wrong, want to see the "real" doctor, can prove how wrong they are with WebMD, etc. My spouse is now doing her 13th and 14th year of post-secondary training toward the goal of being a specialized surgeon. She has done hundreds of successful surgeries/procedures already and saved countless lives. Yet, she is burnt out, and often ends her workdays completely destroyed by the humiliation of being a cog in the hospital machine. She is not alone; physician depression and suicide is at all-time highs. "... and hinges on branding and the exclusivity of becoming a doctor." Like I said, she is on her 13th and 14th year of post secondary training. Aside from this being a massive time investment, it also cost her dollars she didn't have (no support from parents) on order of $300k in post-secondary education, just in tuition. If becoming a doctor is "exclusive" and confers a "brand", I'd say the exclusivity is "extreme passion for helping humans at great personal sacrifice and cost", and the conferred "brand" is that you are allowed to practice medicine, at all. "Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are." Medicine -- and the tireless and ethical work of thousands of well-trained and professional doctors -- saves countless, countless lives every single day. Modern medical treatments are not "worthless" and your comment is honestly insulting to how effective and life-saving many treatments are. I think this part of your comment is what got the rise out of me: spreading this kind of misinformation is the closest thing HN commenting gets to "malpractice". Society should respect and pay doctors much more for the sacrifice they put toward this profession. Patients should respect doctors a lot more for the benefit they provide society. Hospitals should give doctors a better work environment. Doctors are not perfect, nor is medicine. But to think the root cause of problems in the present medical system is an undeserving respect for doctors and modern medical treatments expresses a profound ignorance of reality. The original comment is so wrong that it truly stunned me into an uncharacteristically curt ad hominem response, for which I apologize.